AB1394 ON-FLARE RETREATMENT WITH RITUXIMAB IN RHEUMATOID ARTHRITIS: PATIENTS’ AND RHEUMATOLOGISTS’ PERCEPTIONS
Authors: D. Bertrand, A. Deprez, M. Doumen, D. De Cock, S. Pazmino, A. Marchal, M. Thelissen, J. Joly, B. Neerinckx, R. Westhovens, P. Verschueren
Journal: Annals of the Rheumatic Diseases (2022)

Background Rituximab is an efficacious drug for the treatment of Rheumatoid Arthritis (RA). According to literature, administration of rituximab can be based on a fixed interval or on relapse of disease activity. In some countries, like Belgium, after the first rituximab cycle a flare is required for reimbursement of a subsequent cycle. A better understanding of the perceptions of patients and rheumatologists regarding this retreatment strategy would be informative in view of potential adjustments. Objectives The aim was to investigate patients’ and rheumatologists’ perceptions on the on-flare retreatment strategy of rituximab. Methods Patients with RA, who were currently or previously treated with rituximab, and rheumatologists were invited to participate in a qualitative study consisting of individual, in depth, face-to-face, semi-structured interviews. Participants were recruited based on purposive sampling to ensure diversity. Interviews were conducted via video or telephone call. Additional participants were interviewed until data saturation was achieved, meaning no new information emerged from the last 3 interviews. Interviews were audiotaped and transcribed verbatim, followed by analysis according to the Qualitative analysis guide of Leuven, which generated themes and subthemes. Patient experts were involved in this research. Results In total, 16 patients with RA and 13 rheumatologists were interviewed. Five overarching themes were generated from the interviews: flare definition, recognition, reaction, balance between benefits and barriers and suggestions (Figure 1). Patients and rheumatologists described how they perceive the on-flare retreatment strategy in daily practice, starting with the FLARE DEFINITION itself. Namely, what patients perceived as a flare and the impact of this flare. The second step was RECOGNITION of the flare. Both rheumatologists and patients indicated that patients are able to recognise a flare. However, the patient’s ability to discriminate between inflammatory and other types of pain was perceived as a difficulty. Moreover, patients indicated that depending on the flare’s intensity, they can cope with it themselves, delaying the need for a rituximab cycle. The next step after correctly recognising a flare, was the REACTION , from both the patient’s and rheumatologist’s side. It was stressed that patients must contact their treating rheumatologists in time. Furthermore, a swift response of the rheumatologists was perceived as important. After confirming eligibility, the shared decision to plan a new rituximab cycle can be made while keeping an eye on the organisation. Remarkably, it seemed that rheumatologists approached the retreatment strategy in different ways, meaning that not everyone adhered to the on-flare principle. Several perceived BENEFITS (e.g. lower safety risk, societal cost savings) and BARRIERS (e.g. disease activity fluctuations, slow working mechanism) were mentioned, making clear that the optimal retreatment strategy should be based on a BALANCE between both. Finally, some SUGGESTIONS (e.g. biomarkers for flare prediction, subcutaneous administration of rituximab) were brought up that could be helpful in applying the optimal retreatment strategy. Figure 1. Conceptual framework of the perceptions of patients and rheumatologists regarding the on-flare retreatment strategy with rituximab. SDM = Shared decision making. (Icons: Iconfinder) Conclusion Patients play an important role in the recognition of flares and their reaction, in shared decision with the rheumatologist, contributes to the effectiveness of the rituximab on-flare retreatment strategy. Rheumatologists handle the on-flare retreatment strategy as pragmatically as possible, resulting in different approaches. Moreover, both benefits and barriers of on-flare retreatment were perceived, making clear that a balance should be found to determine the optimal retreatment strategy. Disclosure of Interests None declared